chapter  10
‘Mammography at age 40 to 49 saves lives; just not enough of them’: gendered political intersections in communicating breast cancer screening policy to publics
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In this chapter, we investigate ways that gender – and other identities – are complicated as a result of policymaking processes. Public relations is integral to policymaking processes as communication practitioners often strategize and implement new policies as well as communicate policies to relevant groups (Heath and Palenchar 2009). Public relations is also characterized by gender (Aldoory and Toth 2002) and racial (Pompper 2007; Sha and Ford 2007) discrepancies among its practitioners and miscommunications based on cultural gaps between practitioners and publics (Sison 2009; Vardeman-Winter and Tindall 2010). Thus, we propose that gender and other identities are intimately tied to the inequitable consequences that result from politicized relationships. The policies that result in inequitable consequences are due, in part, to

cultural gaps between policymakers/communicators and publics. The particular mixes of identities influence and maintain these cultural gaps, which impede communication. For example, those enacting and communicating policy change have sophisticated levels of specialized education about social issues whereas publics represent a wide spectrum of literacy on public health, education, politics, and economics. These distinct levels of knowledge may also be intricately tied to other identities, such as race, class, age, and nationality. Public relations activities can have significant implications for gendered

relationships and social practice. This was evident when a long-standing, widespread health policy was changed in the United States in 2009. Breast cancer screening guidelines were changed by a small group of medical professionals with specialized medical knowledge, and this change in mammography screening guidelines affects all women who reside in the United States (and potentially globally). Although these guidelines are specific to US policies and publics, US federal agencies and NGOs work with international health groups to establish knowledge sharing of best practices in

healthcare screening guidelines and to provide funds for reducing morbidity and mortality rates of health disparities globally. The revised policy left the media and other publics with myriad questions.

Chiefly, women and public health advocates fear that mammograms may not be recommended for women aged between forty and forty-nine and that this will likely adversely affect women from non-white, non-middleclass backgrounds. As the health policy carries significant potential consequences for many different groups, we sought to learn what the consequences were of the policy communication for the identities of the publics of this policy. This case study offers insight into the role public relations plays in

producing problematic gendered policies that exacerbate problems for women publics of different races, ages, and classes. We propose that gender identity matters in policymaking and communication about policy change. As such, this study orients gender as a salient identity from which to examine how both powerful and marginalized groups negotiate policy change. At a surface level, gender emerges as relevant to public relations because of the overwhelming majority of women as the corpus of US communication practitioners, which designates public relations as a gendered industry (Aldoory 2009; Daymon and Demetrious 2010; Wrigley 2010). Thus, the nexus between public relations and policymakers indicates that we should begin questioning what public relations practitioners can do to address this as a problem. To critique these processes, we explain the background to the con-

troversial policy change in the public health realm. Then, to ground the work theoretically, we provide a fundamental understanding of gender-only analysis, race-only analysis, and the convergence of those two analytical structures – the intersectional approach. Our main propositions about gendered political intersectionality are presented to explain the connection between gendered intersections, policymaking, and communication, followed by details of how we studied the phenomenon. Having talked to publics about the cancer screening changes and after examining documents by the policymaking group, we present a number of challenges that reveal how the assumptions about gender and identity that are made by policymakers influence their decision-making and can lead to inequitable consequences for gendered publics. The chapter closes with a discussion about how political intersectionality can provide a useful critique of evaluations of policies enacted by communicators.